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Effective January 1, 2015, precertification will be required for
outpatient radiation therapy for all commercial AmeriHealth HMO members in
Pennsylvania. AmeriHealth is working with CareCore National, LLC (CareCore) to
manage precertification requests for outpatient, non-emergent radiation therapy
services. Precertification is not required when radiation therapy is rendered
in the inpatient hospital setting.
To initiate precertification for
outpatient radiation therapy, a new option will be added to the
NaviNet® web portal within the Authorizations transaction that
will link to CareCore's provider portal. Providers will also be able to
initiate precertification requests by calling CareCore directly at 1-866-686-2649.
Network radiation therapy centers
will receive a letter describing the new precertification process through
CareCore in greater detail. Additionally, look for more information about this
change in future editions of Partners in Health
UpdateSM.
Note: This precertification requirement
does not apply to commercial HMO and PPO or Medicare Advantage HMO members in
New Jersey.
Precertification for other radiology services
Precertification
requests for all high technology diagnostic imaging services (e.g., CT, MRI,
PET) will continue to be handled through the current process with AIM Specailty
Health®.
NaviNet® is a registered trademark
of NaviNet, Inc.
]